Current opinions in inguinal hernia emergencies: A comprehensive review of related evidences

Abstract

INTRODUCTION: Groins hernia emergencies are evaluated under two definitions: incarceration that is defined as a hernia in which its content becomes irreducible at the passage in the abdominal wall and strangulation that compromises the blood supply to the omentum and/or intestines within the hernia sac. The purpose of this paper was to determine the latest knowledge about groin hernia emergencies. MATERIALS AND METHODS: PubMed and Google Scholar searches were done by using combinations of “inguinal hernia” and “emergency”, and “groin hernia” and “emergency” keywords at first. More detailed searches were performed to enrich the “Surgical treatment” part of the paper by using “emergency hernia” and “mesh”, “emergency hernia,” and “laparoscopic versus open” keywords afterward. RESULTS: Approximately 5%–10% of all inguinal repairs are performed in emergency settings. Both lateral and medial inguinal hernias can get incarcerated or strangulated, whereas the risk for femoral hernias is higher. Manual reduction of incarcerated inguinal hernias is successful in approximately 60% of the cases. The prediction of bowel ischemia due to strangulation may be possible with some blood tests and imaging studies like ultrasound and computed tomography. It has been shown that the longer the duration of incarceration the higher the risk of bowel ischemia. Bowel resection which is more frequently necessary in patients with advanced age, female gender, and femoral hernia, is associated with an increased risk of perioperative mortality. Some surgeons still use tissue-suture repairs in an emergency setting; however, mesh repairs have been shown to be safe unless there is an overt contamination. CONCLUSION: Early treatment of complicated groin hernias is the key to favorable outcomes. The need for bowel resection and advanced age are the most prominent factors for morbidity and mortality. Mesh repairs are safe in most cases. Minimally invasive approaches promise good results in experienced centers.